Fortnight Application Form

CISV DFW Fortnight Application
1. Application portion due by January 10, 2025
- Online Fortnight Application
- Youth Delegate Reference Form - 1 references required*
  - School teacher, principal, Director, or Grade Coordinator
  - Family friend, coach, or youth leader
- Application Fee $50 payable to CISV DFW PayPal dfw@cisvusa.org
*In order to maintain confidentiality, you will provide your reference with the link to the Youth Delegate Reference Form. Your references will submit the completed form directly to CISV DFW through the online form. We believe that a more accurate reference can be given from someone who has had an entire year to get to know you since these references are due so early in the current school year.

2. Attend Selection Overnight January 17-18, 2025

Fortnight applicants are required to attend the Selection Overnight January 17-18, 2025. Information about the time and location for the selection overnight will be provided in an email once your application is complete.

Questions? Contact: dfw@cisvusa.org
Fortnight Application Form
Thank you for your interest in CISV!

Please remember to provide your reference with a link to the Youth Delegate Reference Form.
Name

First NameLast Name
Gender Identity
Date of Birth (month/day/year) - example: 02/06/2008
What Racial identity/ethnicity
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Cell Phone Number
Please enter a valid phone number.
Applicant Current School (if applicable)
Applicant Current Employment (if applicable)
What is your first language?
Do you speak any other languages? If so, indicate the language(s) and your level of fluency (low, average, high)
Short Answer Questions
What are your interests and hobbies?
What are your activities outside of school?
How did you learn about CISV?
Do you have any experience with CISV or other intercultural organizations or travel programs?
What do you see as the benefits of Fortnight, a program including participants from the USA only?
Why do you want to be a part of Fortnight?
Parent/Guardian Information
Parent/Guardian 1 Name (Please list in order of who to contact first)*

First NameLast Name
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 Occupation
Parent/Guardian 1 Employer
Parent/Guardian 1 Cell Phone Number
Please enter a valid phone number.
Parent/Guardian 1 Email
example@example.com
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Occupation
Parent/Guardian 2 Employer
Parent/Guardian 2 Cell Phone Number
Please enter a valid phone number.
Parent/Guardian 2 Email
example@example.com
CISV requires that both custodial parents/guardians sign this application form (see last page for signature lines), thus confirming that the applicant has permission from both custodial parents/guardians to travel. If an applicant is selected, all additional required CISV forms can be signed by just one custodial parent/guardian, unless CISV is informed in advance of custody issues that make necessary the signatures of both.
*Check the box that best describes your situation:
Notes
*Documentation of full legal custody must be provided
Parent/Guardian 1 Short Answer Questions
Why do you want your child to participate in CISV?
What are your current volunteer activities?
Will you be able and willing to volunteer with CISV if your child is selected?
Parent/Guardian 2 Short Answer Questions
Why do you want your child to participate in CISV?
What are your current volunteer activities?
Will you be able and willing to volunteer with CISV if your child is selected?
Applicant Medical History
Do you take prescription medication? If so, please elaborate below.
List any allergies or dietary restrictions and their effect on your daily activities.
If you are selected, a physician's declaration of your health and fitness for CISV participation will be required.
National Code of Conduct Agreement
I, First Name Last Name , do agree with my local CISV Chapter and the National and International officers of CISV to participate fully in Fortnight. I will abide by the guidelines established by CISV International, INFO FILE R-7 (9008), in such manner that will enhance our life together and foster courtesy and understanding between us all. I will not bring or use illegal drugs. If I am under the age of 18 and smoke, I will bring a signed letter of consent from my parents or guardians. If I am in a country where there is no legal age for drinking and I am under 21, I will furnish a signed letter of consent from my parents or guardians. In all cases I will observe the wishes of my host family regarding drinking and smoking as a matter of courtesy. I will observe such sexual mores and behaviors that will not embarrass or injure others (such behaviors having been discussed with my parents/guardians). I understand I will be expected to participate in all CISV activities (games, culture sharing, crafts, singing, dances, meetings and workshops, etc.) and I agree to participate to the best of my ability. I further agree to represent my CISV Chapter in a manner that is consistent with the values of my home, community and country.
I understand that if I break my agreement, I may be removed from the program at my own expense.
National Travel Policy
Individual travel (as in the case of Leaders, Junior Counselors and Fortnight participants) other than to and from the site of an approved CISV activity shall be deemed non-CISV travel. CISV assumes no responsibility or liability for an individual while on a side trip or layover in excess of 24 hours.
Agreement
In signing this application, we (applicant and parents/guardians) confirm that:

I have read, understand, and agree to abide by the National Code of Conduct Agreement and the CISV USA Travel Policy.The information we have provided in this application may be verified by contacting individuals and agencies other than those listed in this application.I release and hold harmless any individual or organization that provides additional information about me to CISV. I also hold harmless any officers or volunteers of CISV International, CISV USA, or the local Chapter of CISV.All information provided on this application is true and correct.I understand that if I break my agreement, I may be removed from the program at my own expense.
Applicant Signature

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Applicant Signature Date

MonthDayYear
Date
Parent/Guardian 1 Signature

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Parent/Guardian 1 Signature Date

MonthDayYear
Date
Parent/Guardian 2 Signature

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Parent/Guardian 2 Signature Date

MonthDayYear
Date
Should be Empty:

CISV DFW Fortnight Application

Fortnight Application Form

Short Answer Questions

Parent/Guardian Information

Parent/Guardian 1 Short Answer Questions

Parent/Guardian 2 Short Answer Questions

Applicant Medical History

National Code of Conduct Agreement

National Travel Policy

Agreement